Provider First Line Business Practice Location Address:
2255 N LAKEWOOD BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90815-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-498-8000
Provider Business Practice Location Address Fax Number:
562-494-8880
Provider Enumeration Date:
07/21/2006